Sleep/Wake Disorders
Insomnia accounts for the highest percentage of sleep disorders today. Many
individuals struggle to fall asleep and maintain sleep. They wake up tired and
unable to complete their activities of daily living efficiently (Gupta et al., 2017). This
discussion attempts to evaluate a client experiencing insomnia and propose
pharmacological interventions to improve sleep quality and prevent interruptions
during the night.
Questions to ask the Client
Three questions during the clinical interview for the patient would include
I. Describe your sleep pattern. When did you begin experiencing
difficulty sleeping? Per Gupta et al. (2017), knowing when sleep
disturbance symptoms started helps with diagnosing a sleep
disorder.
II. Do you have thoughts of harming yourself or others? Per the
guidelines from the American Psychiatric Association (APA) for
assessing patients with psychiatric disorders, it is essential to
establish the safety of the patient and the people around them
and to help plan for treatment (American Psychiatric Association
[APA], 2015).
III. How many times do you use your inhaler in a day? A high dose of
corticosteroids is linked to insomnia and anxiety (Russo et al.,
2013).
Questions to ask others
The client is single, but we know she has parents and siblings. There was no
mention of a significant other; however, such a person would also be a good source of
information about the client’s habits and behavior. Another resource person would be
the client’s sponsor from alcoholics anonymous. Some questions to ask would be
I. What are some events or situations that may trigger a traumatic
response from the client? Knowing the client’s trigger can help
direct therapy (Watkins et al., 2018).
II. Tell me about the client’s childhood. This information would
information about the client’s experiences as a child and growing
up and help direct future treatment. Post-traumatic stress disorder
treatments target facing the trauma or addressing the bad
experience that causes stress (Watkins et al., 2018).
III. Describe the client’s demeanor and behavior during the day after a
good sleep. According to Gupta et al. (2017), symptoms of some
psychiatric disorders like depression can mimic the consequences
of sleeplessness like fatigue and inability to stay focused.
, Physical Examinations and Diagnostic Tests
Several tests and examinations would be needed before the clinician can start
prescribing pharmacologic interventions for the client. The client has several medical
problems and is taking various medications. Therefore, tests like a complete
metabolic panel can assess her kidney function, liver function, and electrolyte levels.
Other blood tests would include a lipid panel, thyroid hormone levels, hemoglobin
A1C, and genome testing for the CYP4502D6 allele to assess any drug-metabolizing
deficiencies. The client would need an electrocardiogram to evaluate her
cardiovascular health, body mass index to evaluate her weight, and an eye exam to
check for cataracts and diabetic retinopathy before starting any medication regimen.
Many psychotropic medications can cause weight gain leading to many metabolic
problems, including diabetes, high cholesterol, and heart disease (Stahl, 2013). Even
though the client already has all these medical issues, these tests would help the
clinician assess the client’s health status before proceeding with interventions.
Three Differential Diagnoses
The client has an extensive medical history, including substance use disorder,
which she gets support through alcoholics anonymous (AA). Her thorough interview
information points to diagnoses, including:
I. Post-traumatic disorder (PTSD). This disease may develop after
exposure to trauma, loss, abuse, or a natural disaster (Watkins
et al., 2018). The client has a history of trauma during her
childhood, from which she reports flashbacks, nightmares, and
panic attacks that prevent her from sleeping at night.
II. Major Depressive Disorder — The client reports sleeplessness, mood
swings, anxiety, and low energy level. According to the APA (2015),
individuals with the major depressive disorder exhibit these
symptoms.
III. Insomnia — The client reports inability to sleep at night for most
nights. Insomnia is defined as problems falling asleep, staying
asleep, or getting a full night’s sleep for at least three nights per
week for one month (Gupta et al., 2017).
The most likely diagnosis based on the client’s history is a post-traumatic stress
disorder.
Insomnia accounts for the highest percentage of sleep disorders today. Many
individuals struggle to fall asleep and maintain sleep. They wake up tired and
unable to complete their activities of daily living efficiently (Gupta et al., 2017). This
discussion attempts to evaluate a client experiencing insomnia and propose
pharmacological interventions to improve sleep quality and prevent interruptions
during the night.
Questions to ask the Client
Three questions during the clinical interview for the patient would include
I. Describe your sleep pattern. When did you begin experiencing
difficulty sleeping? Per Gupta et al. (2017), knowing when sleep
disturbance symptoms started helps with diagnosing a sleep
disorder.
II. Do you have thoughts of harming yourself or others? Per the
guidelines from the American Psychiatric Association (APA) for
assessing patients with psychiatric disorders, it is essential to
establish the safety of the patient and the people around them
and to help plan for treatment (American Psychiatric Association
[APA], 2015).
III. How many times do you use your inhaler in a day? A high dose of
corticosteroids is linked to insomnia and anxiety (Russo et al.,
2013).
Questions to ask others
The client is single, but we know she has parents and siblings. There was no
mention of a significant other; however, such a person would also be a good source of
information about the client’s habits and behavior. Another resource person would be
the client’s sponsor from alcoholics anonymous. Some questions to ask would be
I. What are some events or situations that may trigger a traumatic
response from the client? Knowing the client’s trigger can help
direct therapy (Watkins et al., 2018).
II. Tell me about the client’s childhood. This information would
information about the client’s experiences as a child and growing
up and help direct future treatment. Post-traumatic stress disorder
treatments target facing the trauma or addressing the bad
experience that causes stress (Watkins et al., 2018).
III. Describe the client’s demeanor and behavior during the day after a
good sleep. According to Gupta et al. (2017), symptoms of some
psychiatric disorders like depression can mimic the consequences
of sleeplessness like fatigue and inability to stay focused.
, Physical Examinations and Diagnostic Tests
Several tests and examinations would be needed before the clinician can start
prescribing pharmacologic interventions for the client. The client has several medical
problems and is taking various medications. Therefore, tests like a complete
metabolic panel can assess her kidney function, liver function, and electrolyte levels.
Other blood tests would include a lipid panel, thyroid hormone levels, hemoglobin
A1C, and genome testing for the CYP4502D6 allele to assess any drug-metabolizing
deficiencies. The client would need an electrocardiogram to evaluate her
cardiovascular health, body mass index to evaluate her weight, and an eye exam to
check for cataracts and diabetic retinopathy before starting any medication regimen.
Many psychotropic medications can cause weight gain leading to many metabolic
problems, including diabetes, high cholesterol, and heart disease (Stahl, 2013). Even
though the client already has all these medical issues, these tests would help the
clinician assess the client’s health status before proceeding with interventions.
Three Differential Diagnoses
The client has an extensive medical history, including substance use disorder,
which she gets support through alcoholics anonymous (AA). Her thorough interview
information points to diagnoses, including:
I. Post-traumatic disorder (PTSD). This disease may develop after
exposure to trauma, loss, abuse, or a natural disaster (Watkins
et al., 2018). The client has a history of trauma during her
childhood, from which she reports flashbacks, nightmares, and
panic attacks that prevent her from sleeping at night.
II. Major Depressive Disorder — The client reports sleeplessness, mood
swings, anxiety, and low energy level. According to the APA (2015),
individuals with the major depressive disorder exhibit these
symptoms.
III. Insomnia — The client reports inability to sleep at night for most
nights. Insomnia is defined as problems falling asleep, staying
asleep, or getting a full night’s sleep for at least three nights per
week for one month (Gupta et al., 2017).
The most likely diagnosis based on the client’s history is a post-traumatic stress
disorder.
